Objectives: Early studies on COVID-19 vaccine hesitancy showed varied intensity across countries, which was linked to various factors such as socio-economic conditions, information sources, and issues of trust in government, scientific experts, and the health sector. This study aims to evaluate the determinants of vaccine hesitancy to offer insights into the strategies that may be successful in designing communications campaigns for enhanced vaccination uptake. Methods: Through logistic regression, this study examines correlates of survey data from five Southeast Asian countries, namely Indonesia (ID), Malaysia (MY), Philippines (PH), Thailand (TH), Vietnam (VN) collected by the Massachusetts Institute of Technology Initiative on Digital Economy and Facebook between July 2020 and March 2021. Results: Some significant determinants at the 5% or 1% level of significance of COVID-19 vaccine hesitancy in the countries of interest include gender [ID: 1.17 (1.01, 1.15), MY: 1.35 (1.2,1.53), PH: 1.92 (1.68,2.19), VN: 1.28 (1.04,1.58)], age [MY:1.11 (1.06,1.17), PH: 0.92 (0.88, 0.97), TH: 1.17 (1.11, 1.23)], knowing someone who tested positive for COVID-19 [ID: 0.75 (0.65,0.88), MY: 0.82 (0.71,0.95), PH: 0.76 (0.67, 0.87), TH: 0.76 (0.59, 0.99), VN: 0.72 (0.54,0.97)], and perceived effectiveness of mask wearing [ID: 0.83 (0.74, 0.94), MY: 0.86 (0.79, 0.95), TH: 0.88 (0.8,0.98)]. Vaccine hesitancy is particularly strong among women in 3 countries—peaking at 52% in Indonesia, 42% in Malaysia, and 56% in the Philippines. Conclusion Results from the survey highlight the significance of a targeted vaccine education and research campaign. This study calls for streamlining of communications campaigns towards messages that promote vaccine uptake in the region, while better targeting those groups most vulnerable guided by the empirical findings herein.
Asia

Background: Cardiovascular disease is the leading cause of death in both genders worldwide. Gender differences in clinical presentation and treatment have been reported. Objective: This study aims to describe and compare the cardiovascular risk factors and management strategies for primary prevention among Filipinos. Methods: An analytical cross-sectional study was done on 2,082 patients at the Preventive Cardiology Clinic of a tertiary referral center in Quezon City, Philippines from January 1, 2002 to December 31, 2017. Results: Seventy-two percent of the patients were females with a higher mean age compared to males (57.67 + 10.50 vs 55.66 + 11.82, p 0.002). There were more women who were unemployed (75.2 vs 45.9, p<0.001). There was no significant difference in the prevalence of hypertension (68.6% vs 67.9%, p=0.542) and type 2 diabetes mellitus (19.8% vs 21.5%, p=0.437) in both genders. Beta blockers (24.1%), calcium channel blockers (22.9%) and angiotensin receptor blockers (22.1%) were the most commonly prescribed anti-hypertensive drugs. Biguanides were the most commonly prescribed glucose-lowering drug (11.3%). Compared to men, more women had dyslipidemia (51.8% vs 38.6%, p<0.001). Statins were more commonly prescribed in women (22.4 vs 18.1%, p=0.033). Conclusion There were significantly more women seen in our Preventive Cardiology clinic. Smoking and alcoholic drinking were higher in males. BMI, total cholesterol and HDL were significantly higher in females than in males.
Sex Characteristics ; Heart Disease Risk Factors ; Primary Prevention ; Preventive Medicine

INTRODUCTION: The impact of sex and diabetes mellitus (DM) on patients with heart failure with mildly reduced ejection fraction (HFmrEF) is not well elucidated. This study aims to evaluate sex differences in the clinical profile and outcomes in Asian HFmrEF patients with and without DM. METHODS: Patients admitted nationally for HFmrEF (ejection fraction 40-49%) between 2008 and 2014 were included and followed up until December 2016. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular (CV) death and/or heart failure (HF) rehospitalisations. RESULTS: A total of 2,272 HFmrEF patients (56% male) were included. More women had DM than men (60% versus 55%, P=0.013). Regardless of DM status, HFmrEF females were older, less likely to smoke, had less coronary artery disease, narrower QRS and lower haemoglobin compared to men. The odds of having DM decreases in smokers who are women as opposed to men (P_interaction =0.017). In multivariate analysis, DM reached statistical analysis for all-cause mortality and combined CV mortality or HF rehospitalisation in both men and women. However, the results suggest that there may be sex differences in terms of outcomes. DM (vs non-DM) was less strongly associated with increased all-cause mortality (adjusted hazards ratio [adj HR] 1.234 vs adj HR 1.290, P_interaction <0.001] but more strongly associated with the combined CV death/HF rehospitalisation (adj HR 1.429 vs adj HR 1.317, P_interaction =0.027) in women (vs men). CONCLUSION Asian women with HFmrEF had a higher prevalence of DM, with differences in clinical characteristics, compared to men. While diabetes conferred poor outcomes regardless of sex, there were distinct sex differences. These highlight the need for sex-specific management strategies.
Diabetes Mellitus/epidemiology* ; Female ; Heart Failure ; Humans ; Male ; Prognosis ; Stroke Volume ; Ventricular Dysfunction, Left/epidemiology* ; Ventricular Function, Left

INTRODUCTION: Infant gastroesophageal reflux disease (GERD) is a significant cause of concern to parents. This study seeks to describe GERD prevalence in infants, evaluate possible risk factors and assess common beliefs influencing management of GERD among Asian parents. METHODS: Mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort were prospectively followed from preconception to 12 months post-delivery. GERD diagnosis was ascertained through the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) administered at 4 time points during infancy. Data on parental perceptions and lifestyle modifications were also collected. RESULTS: The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. Infants exclusively breastfed at 3 weeks of life had reduced odds of GERD by 1 year (adjusted odds ratio 0.43, 95% confidence interval 0.19-0.97, P=0.04). Elimination of "cold or heaty food" and "gas producing" vegetables, massaging the infant's abdomen and application of medicated oil to the infant's abdomen were quoted as major lifestyle modifications in response to GERD symptoms. CONCLUSION Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. Infants exclusively breastfed at 3 weeks had reduced odds of GERD. Cultural-based changes such as elimination of "heaty or cold" food influence parental perceptions in GERD, which are unique to the Asian population. Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD.
Female ; Gastroesophageal Reflux/epidemiology* ; Humans ; Infant ; Infant, Newborn ; Male ; Parents/psychology* ; Prevalence ; Risk Factors ; Singapore/epidemiology*

Objective: This study assesses the prevalence of musculoskeletal (MSK) pain in patients attending primary care clinics in a medium-sized town in Malaysia and examines the interventions given for the symptoms and the level of the associated disabilities. Method: This investigation comprises a cross-sectional descriptive study of all patients visiting two primary care clinics aged 18 years and above. Patients presenting with joint pain answered a questionnaire assessing demographic data, disabilities (measured by the Stanford HAQ-DI), and treatment options. Results: Of 1,074 patients surveyed, 202 (18.8%) had MSK complaints. The mean age of those with MSK pain was 56.1 years. Incidence increased with age, reaching 78.8% of those over 48 years of age. The knee was the most common site of MSK pain (52.2%), with 20.3% requiring referral for specialist assessment. The median HAQ score was 0.375 and 89.6% of those surveyed had mild disability. Conclusion: MSK pain is a common problem among patients visiting primary care clinics. The most common site of MSK pain was the knee. On formal assessment, the majority of these patients exhibited mild disability. A significant proportion of patients still required specialist referral. This finding would suggest a need for further training on the management of MSK disease at the primary care level to avoid over-burdening the secondary care services.

INTRODUCTION: This study examined maternal, delivery and infant factors associated with cord thyroid-stimulating hormone (TSH) concentrations in an Asian population. METHODS: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is a mother-offspring birth cohort from 2 major hospitals in Singapore. Cord serum TSH was measured using the Abbott ARCHITECT TSH Chemiluminescent Microparticle Immunoassay and the ADVIA Centaur TSH-3 Immunoassay. After excluding infants with a maternal history of thyroid disease, screening cord TSH results from 604 infants were available for multivariable regression analysis in relation to the factors of interest. RESULTS: Babies born by vaginal delivery had significantly higher cord serum TSH concentrations than babies born by caesarean section. Cord serum TSH concentrations differed significantly by measurement method. There was no association of cord TSH concentrations with ethnicity, sex, birth weight, gestational age, maternal body mass index, gestational weight gain, gestational diabetes mellitus status and other maternal, delivery and infant factors studied. CONCLUSION Interpretation of cord serum TSH results may need to take into account mode of delivery and measurement method.

Background/Aims: Data on treatment efficacy and safety of glecaprevir/pibrentasvir (GLE/PIB) for chronic hepatitis C virus (HCV) infection in Asian patients with severe renal impairment are limited. This study aimed to study the treatment and side effects of GLE/PIB in these patients infected with non-1 genotype (GT) HCV. Methods: We prospectively recruited patients with Child’s A cirrhosis and eGFR <30 mL/min/1.73 m2 in Hong Kong and Taiwan during 2017–2018 to receive GLE/PIB treatment. Results: Twenty-one patients (GT2, n=7; GT3, n=6; and GT6, n=8) received GLE/PIB for 11.2±1.8 weeks. All except one were treatment-naïve. GLE/PIB was initiated in 16 patients while on dialysis (seven on peritoneal dialysis [PD] and nine on hemodialysis) and in five patients before dialysis. One patient died of PD-related peritonitis during treatment and two were lost to follow up. The SVR12 rate in the remaining 18 patients was 100%. All patients achieved undetectable levels at 4-, 12-, 24- and 48-week after treatment. Patients with deranged alanine aminotransferase showed normalization after 4 weeks and the response was sustained for 48 weeks. No significant adverse event was observed. Conclusions GLE/PIB treatment was associated with high efficacy and tolerability in HCV-infected patients with severe renal impairment.

Background: A rise in the number of immunocompromised patients has increased the risk of opportunistic fungal infections. Identifying novel sources of antifungal agents from commonly discarded materials (i.e. potato peelings) can provide a cheaper alternative for antifungal drugs.

Objectives: The aim of the study was to determine the antifungal activity of crude glycoalkaloid extract from Solanum tuberosum L. (white potato) peelings against opportunistic fungi Candida albicans, Candida glabrata, Aspergillus niger, Aspergillus fumigatus, and Aspergillus flavus.

Methods: The glycoalkaloid content from dried potato peelings were extracted using ethanol and confirmed using colorimetric tests.The extract had a concentration 833.33 microgram/mL. Determination of the minimum inhibitory concentrations (MICs) of the extract via two-fold broth dilution was performed for the five fungi with amphotericin B and fluconazole as the reference antifungal drugs.

Results: MICs of the crude extract for C. albicans, C. glabrata, A. fumigatus, and A. niger were not found within the concentration range of the studies and would thus need further experiments using a broader range of glycoalkaloid concentrations. The extract was found to have a MIC of 104.17microgram/mL for A. flavus, thereby verifying the antifungal effect of glycoalkaloid against A. flavus at said concentration.

Conclusion: Glycoalkaloids from Solanum tuberosum are a potential source of antifungals against certain opportunistic fungi.

BACKGROUND: Many of the leading causes of mortality and morbidity in the Philippines are controllable with nature-based products, either as agents of intervention, or prevention, as nutritional supplements or for the control of side-effects of medications. The different R&D programs on nature-based products in the Philippines are usually conducted in isolation, or through silos. These often lead to products that are shortsighted, duplicate products, or products with minimal innovation, not readily applicable to population and environmental sustainability.

OBJECTIVE: The study aimed to draft an internationally benchmarked and integrated blueprint for a population health and environmental health-led nature-based product development and conservation for the Philippines.

METHODS: The methodology consisted of a review of literature; regional educational visits; and a series of consultative meetings with stakeholders.

RESULTS: The study resulted in a stakeholder-validated blueprint that assigns the Philippine Institute of Traditional and Alternative Health Care (PITAHC) to lead the way for Filipinos to produce more nature-based products that are of international quality and attuned with local health needs. The blueprint has identified "9 Optimizations" in the realization of this aspiration, including an expanded role for PITAHC, a national database, an ethical researchers list, and to produce at least five commercial products and 20 intellectual property rights within 5 years with an estimated total investment of approximately PhP 816 M.

Eribulin, an antimicrotubule chemotherapeutic agent, is approved for the treatment of pretreated metastatic breast cancer (mBC) based on the positive outcomes of phase II and phase III clinical trials, which enrolled mainly Western patients. Eribulin has recently been approved in an increasing number of Asian countries; however, there is limited clinical experience in using the drug in certain countries. Therefore, we established an Asian working group to provide practical guidance for eribulin use based on our clinical experience. This paper summarizes the key clinical trials, and the management recommendations for the reported adverse events (AEs) of eribulin in mBC treatment, with an emphasis on those that are relevant to Asian patients, followed by further elaboration of our eribulin clinical experience. It is anticipated that this clinical practice guide will improve the management of AEs resulting from eribulin treatment, which will ensure that patients receive the maximum treatment benefit.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Humans